COVID-19 Preparedness And Response Plan

UPDATED 7/2/2020

Scope: This procedural plan applies to

  • Consumers receiving CLS services
  • Consumers living in licensed setting
  • All persons entering a TLC clinic
  • All Team Members

In response to Governor Whitmer’s Executive Order 91 TLC has developed the following plan. The procedures within this plan must be adhered to by all TLC team members while performing work functions for TLC, regardless of the setting (consumer’s home, outpatient clinic, or administrative office) in which the work function is occurring. All directors and supervisors must be familiar with this plan and be ready to answer questions from team member. Directors and supervisors must set a good example by following this plan at all times. This involves practicing good personal hygiene and jobsite safety practices to prevent the spread of the virus. Directors and supervisors must encourage this same behavior from all team members.

TLC is asking every team member to help with our prevention efforts while at work. In order to minimize the spread of COVID-19 at our worksites, everyone must play their part. As set forth below, TLC has instituted various housekeeping, social distancing, and other best practices at our worksites. All team members must follow these. In addition, team members are expected to report to their supervisors if they are experiencing signs or symptoms of COVID-19, as described below. If you have a specific question about this plan or COVID-19, please ask your supervisor. If they cannot answer the question, please contact Chelsea Gleason, HR Director.

The procedures within this plan supplement, not replace, the procedures outlined in TLC’s Health and Safety Plan and remain in effect until COVID-19 no longer presents a risk for widespread infection.

This COVID-19 Preparedness and Response Plan is made available to TLC team members (via SharePoint) and customers (via TLC website).

  1. PLAN OVERSIGHT:
    1. There must be a person assigned as a worksite supervisor designee on-site at all times when team members are present who is responsible to implement, monitor, and report on the COVID-19 control strategies included in this plan. The worksite supervisor designation may be shared by more than one person to cover multiple shifts; however, each worksite supervisor designee must be familiar with this plan and have the ability to implement, monitor, and report on the COVID-19 control strategies.
      1. Calhoun CLS designees:
        1. Hill House: TBD
        2. Quad: TBD
      2. Flint clinic designees: based on an assigned schedule (see Attachment A)
      3. Macomb clinic designees: Sax Guthery and Beth Calzetta
      4. Mason designee: Inetta Soule (Jen Griese and Kim Rogers, backups)
      5. Owosso clinic designees: Brienna Crandall and Taylor McCreery
      6. Shiawassee Residential/CLS: Home manager at each location. For locations with a second shift, one staff member is designated for each location. For CLS locations that are not staffed 24/7, the team member assigned to provide the service is designated.
         
  2. TRAINING:
    1. All team members receive orientation and annual training regarding:
      1. Workplace infection-control practices;
      2. How to report unsafe working conditions;
    2. Within 48 hours of adoption of this plan all team members working onsite at TLC must receive training regarding:
      1. Steps the team member must take to notify TLC of any symptoms of COVID19 or a suspected or confirmed diagnosis of COVID-19 (team members are to self-quarantine and call their program director and the Human Resources department);
      2. How to conduct a daily entry self-screening protocol for all team members entering the worksite, including, at a minimum, a questionnaire covering symptoms and suspected or confirmed exposure to people with possible COVID-19;
      3. Encourage team members to use personal protective equipment (PPE) and hand sanitizer in public situations (including public transportation);
      4. How to keep everyone on the worksite premises at least six feet from one another to the maximum extent possible, including through use of ground markings, signs, and physical barriers, as appropriate to the worksite;
      5. Requirements for use of PPE;
      6. Requirements for facility cleaning and disinfection to limit exposure to COVID-19 and availability of cleaning supplies;
      7. Protocol to clean and disinfect the facility in the event of a positive COVID-19 case in the workplace
         
  3. SOCIAL DISTANCING:
    1. Team members are encouraged to maintain social distancing guidelines established by Governor Whitmer’s executive order during non-work periods.
    2. Team members are required to wear a mask and to maintain a social distance of not less than 6 feet from all persons while completing work functions for TLC unless they are completed in the team member’s residence.
      1. Team members that work alone in an office are not required to wear a mask while in the office with the door closed; however, a mask should be readily available and utilized whenever somebody enters the room.
      2. Team members should refrain from entering another team member’s office space without knocking on the door and providing the person inside the office time to put on their mask. The team member inside the office should tell the visitor when it is okay to enter the room.
    3. Except in the two licensed residential homes (Matthews House and State Road), during face-to-face contact with a consumer both the team member and the consumer are required to wear a mask.
      1. This procedure is required not only in clinic locations but also when providing face-to-face services in a consumer’s home and in the community.
    4. Team members are responsible to encourage consumers to engage in proper social distancing by observing the floor markers. Floor markers must be placed 6 feet apart in reception rooms and high traffic hallways.
    5. In situations where team members share a workspace with one or more other persons where workstations are less than 6 feet apart, in cooperation with the program director/designee, arrangements must be made to ensure the maintenance of social distancing such as:
      1. Staggering work hours so that co-team members are not present at the same time;
      2. Temporary reassignment of workstations to less congested locations;
      3. Provision of PPE (including face shields) that will allow for breaking the 6 feet barrier.
      4. Flint case managers will schedule their in-office hours on days their immediate supervisor is on-site so as to slow the flow of traffic.
        1. If a case manager needs to come to the office on an alternate day, they are to coordinate with the supervisor who is on-site at that time.
        2. Supervisors will ensure that only 1 case manager is working in each cubicle space at any given time.
        3. If at any time there is already somebody using a cubicle space that is close to staff, they will need to find a different cubicle to ensure 6 feet distance is maintained at all times.
        4. Per the cleaning protocol below, team members are to sanitize their work area at the beginning and end of the time they are utilizing the cubicle regardless of whether it is their permanently assigned workspace or a temporarily borrowed workspace.
    6. For case management and supports coordination team members who are re-engaging with consumers in the community and traveling between multiple consumers’ homes in a single day:
      1. If the team member is not feeling well, they should stay home.
      2. Ensure team members are adhering to standards included in policy 1.E.12. Safety While Providing Services in the Community.
      3. Prior to providing the service to the consumer, ensure the Risk Assessment is completed with the consumer (either over the telephone before arriving or from a safe distance at the beginning of the contact.
        1. While completing the Risk Assessment, enquire about other persons in the home and establish a plan for maintaining physical distance from those persons
      4. As much as possible and weather permitting, provide the service outside (e.g. in the back yard or, if the consumer does not have private outside space at their home, agree to meet the consumer at a local park or other outdoor space that facilitates a private conversation).
      5. Even while outside, the case manager/supports coordinator must wear a mask in situations where they come within 6 feet of the other individual.
      6. Request the consumer to wear a mask during the visit. 
      7. If the Case Manager/Supports Coordinator must enter the consumer’s home, always wear a mask throughout the visit. This is to protect the team member as well as the consumer.
      8. Minimize the number of personal items carried into a consumer’s home. Take only what is necessary to complete the service and maintain personal safety (e.g. laptop computer, wallet or small purse, cell phone, signature pad, and keys).
      9. Use disinfectant wipes to clean personal items carried into the consumer’s home after each visit.
      10. Refrain from sharing personal items with the consumer (e.g. pen, cell phone) and avoid all physical contact.
      11. If the consumer does not comply with the social distancing standards described in this plan or the environment does not appear to be safe for the case manager/supports coordinator, the service should be terminated until such time as the service can be safely provided.  
      12. Before and after each consumer visit, utilize alcohol-based hand sanitizer.
      13. Avoid touching the face, especially the eyes, nose, and mouth particularly until after they have thoroughly washed their hands upon completing the service and removing PPE.
      14. Case Managers/Supports Coordinators should not return to the TLC office following community contacts with consumers. Rather the team member should go to their home and follow the actions described in section E.p. of this plan. While this plan is in effect, after providing services in the community, indirect work functions should be completed from the team member’s home.
         
  4. CLEANING PROTOCOL:
    1. All team members should frequently and thoroughly wash their hands throughout their work shift.
      1. Wash your hands with soap and water for at least 20 seconds. When soap and running water are unavailable, use an alcohol-based hand rub with at least 60% alcohol
    2. All team members are required to clean and sanitize their individual work area at the beginning and end of their shift and throughout the day as needed. This includes:
      1. Door handles;
      2. Pens;
      3. Chairs;
      4. Tabletops;
      5. Other work items.
    3. Upon completion of each face-to-face consumer contact, team members are required to sanitize their work area.
    4. If a team member uses an interview room, a small group meeting room, board room for a face-to-face appointment, they must sanitize the room after the appointment is complete.
    5. All team members must sanitize the bathroom and kitchen after each use.
    6. Clinic support staff are to sanitize public areas once per hour using disinfecting cleaning solution and paper towels provided each hour after consumers have been checked in. Public areas include:
      1. Waiting room;
      2. Sign-in and sign-out desks;
      3. Pens;
      4. Door handles (outer entrance door, inner entrance door, lobby door, door leading into an office area, reception doors and file room doors);
    7. Clinic support staff must sanitize copiers, printers, and mail area at the beginning and end of each shift using a disinfecting cleaning solution.
    8. Throughout the day, all team members using a copier or printer should sanitize it when they are finished using the disinfecting cleaning solution.
    9. Maintenance staff must sanitize the public restrooms using a disinfecting cleaning solution and paper towels provided each hour after consumers have been checked in or as needed throughout the day (based on traffic and facility size).
    10. Maintenance staff must thoroughly clean doorknobs, bathrooms, and kitchen areas nightly using a disinfecting cleaning solution.
    11. Upon completion of the assigned tasks, team members must update the Enhanced cleaning Daily Checklist.
       
  5. TEAM MEMBER EXPOSURE:
    1. All visitors to a TLC facility must complete the COVID-19 Risk Assessment, including having their temperature taken, prior to conducting their intended business.
      1. COVID-19 Risk Assessments are completed at the reception desks at each clinic and at the front door of the licensed residential homes.
    2. All visitors to a TLC facility must wear a mask. If they do not have a mask, they can request a disposable mask at the reception window.
    3. All reception team members should remain behind a glass barrier or wear a face shield.
    4. Consumers are asked to wait for their appointment in their cars, weather permitting. Consumers will be notified via phone call when their provider is ready to see them.
    5. All persons accompanying consumers are asked to wait in their cars, weather permitting.
    6. Team members should avoid, and encourage consumers to avoid touching their eyes, nose, or mouth with unwashed hands.
    7. Team members should practice, and encourage consumers to practice appropriate respiratory etiquette, which includes coverings for coughs and sneezes.
    8. If a team member is sick, they should follow protocols for remaining home from work.
    9. All team members are to have their temperature taken upon arrival at any TLC location.
      1. If temperature is 100.4° or above the team member must immediately notify their supervisor and verify if they are also experiencing a cough or shortness of breath.
      2. Team members will be sent home and encouraged to contact their primary care physician.
      3. Any team member who experiences symptoms during their shift similar to COVID-19 should contact their supervisor for further evaluation and instruction.
      4. Any team member who has been exposed to a person that has tested positive for COVID-19 must:
        1. Self-quarantine at home for at least 14 days or until such time as they have documentation of a subsequent negative COVID-19 test;
        2. Contact their supervisor for further instructions.
    10. Team members are encouraged to work from home as much as is practicable while serving the needs of TLC and its consumers, such as:
      1. Attending meetings, training, and other congregate activities remotely;
      2. Completing service documentation and other paperwork that does not require face-to-face interaction with consumers or other team members.
    11. When a TLC team member is identified with a confirmed case of COVID-19:
      1. Within 24-hours, notify:
        1. The public health department that serves the county where the TLC facility is located;
        2. The human resources department (it is the responsibility of HR to notify the CEO and Health & Safety Officer);
        3. The director of the program where the team member works;
          1. It is the responsibility of the program director/designee to contact any consumer, team member, or suppliers who may have come into contact with the person with a confirmed case of COVID-19.In the Residential/CLS program, for consumers that TLC has the responsibility of facilitating medical appointments, team members should advocate the use of telehealth technology with the treating provider.
    12. In the Residential/CLS program, team members should restrict community outings until the stay home order is lifted.
    13. TLC will not discharge, discipline, or otherwise retaliate against a team member who stays home or who leaves work when they are at a particular risk of infecting others with COVID-19.
    14. Each program must keep accurate and current data regarding the quantity of each type of appropriate PPE available onsite.
    15. Each program must keep accurate and current data regarding the quantity of each type of appropriate PPE available onsite.
    16. Upon returning home after delivering services to consumers in the community, office, or congregate living facility team members are encouraged to:
      1. Before entering their home:
        1. Remove or change shoes;
        2. Leave all unneeded items outside or in a designated place;
      2. Upon entering their home:
        1. Wash hands with soap and water for at least 20 seconds;
        2. Shower and change their clothes;
        3. Launder items worn in public, including cloth face mask;
        4. Disinfect frequently used items, including their phone, car/house keys, ID badge, laptop computer, etc.
    17. Team members who are experiencing symptoms of COVID-19, have tested positive for COVID-19, or have been asked by a contact tracer to obtain a COVID-19 test may not return to a TLC facility for any reason until they have documentation that they have subsequently tested negative.
      1. Team members in this situation should notify HR upon of their COVID-19 status and keep HR informed about changes in their status throughout the quarantine period.
  1.  EXPOSURE RESPONSE PLAN:
    1. Any persons expressing or displaying symptoms of COVID-19 while at a TLC worksite are asked to safely leave the premises and return home.
    2. At an outpatient clinic, if a team member or guest expresses or displays experiencing symptoms of COVID-19 they should:
      1. Isolate themselves/be provided a location to isolate from other people. This isolation location should be a place that can be quarantined from use for at least 24-hours after the exposure event.
      2. Ensure the symptomatic person wears a face mask at all times in order to limit the spread of respiratory secretions.
      3. While the symptomatic person is in the isolation room, no other persons should enter the room. TLC team members should ensure the person has a working telephone in order to communicate with others outside of the room.
    3. At all TLC locations, with the help of the person experiencing symptoms, develop a list of:
      1. All areas of the facility the person visited that day (be as specific as possible) and the duration of time the person was in each area;
      2. All persons the person came into contact with while at the facility.
    4. As soon as all areas of the facility the person visited that day have been identified, maintenance or support personnel (based on immediate availability) should:
      1. Clean each location where the person was for a short period of time (15 minutes or less) with a disinfecting cleaning solution.
      2. Quarantine areas of the building where the person spent longer durations of time (1 hour or more). All quarantined areas should be cleaned like the isolation room (described below).
    5. Allow the person experiencing symptoms adequate time while in the isolation room to:
      1. Contact primary care physician for instructions about what to do;
      2. Make a plan for where they are going to go when they leave TLC and how they are going to get there (advise persons that have utilized public transportation to get to TLC that they should find safer, less public means of transportation home).
    6. Without entering the isolation room, the worksite supervisor on duty should frequently check in on the wellbeing of the symptomatic person. This can be completed by calling the person or talking through the door.
    7. When the person is ready to leave the TLC facility, they should notify the worksite supervisor.
      1. Prior to allowing the person to exit the isolation room, the worksite supervisor should clear the path between the isolation room and the building’s exit of all persons. It may require the assistance of additional team members to ensure the pathway remains clear of individuals until the symptomatic person has successfully left the building.
    8. Immediately after the symptomatic person leaves the facility, the pathway used to exit should be sanitized using a disinfecting cleaning solution.
    9. After the exposure event has concluded, the isolation room should be quarantined from all other use for a period of 24-hours.
      1. At the end of the 24-hour quarantine period, maintenance staff should thoroughly clean all surfaces and items in the room with a disinfecting cleaning solution.
    10. As soon as possible during or after the exposure event, the worksite supervisor on duty should notify the DHHS and follow their instruction for notification of all persons the symptomatic person identified as having come into contact.
    11. At a licensed residential site or the home of a consumer receiving CLS services, if a team member or guest expresses or displays symptoms of COVID-19 they should:
      1. Guests should leave the facility immediately and seek guidance from their primary care physician. After the guest has left the home, team members should implement sterilization procedures.
      2. Team members who have co-workers present should leave the facility immediately and follow the actions described in section E.k. of this plan.
      3. Team members who are alone on shift should:
        1. If feasible without jeopardizing the resident’s health and safety, terminate the service until such time as a different team member can resume service delivery and leave the home.
        2. If it is not feasible to leave without jeopardizing the resident’s health and safety, immediately distance themselves from residents and maintain at least 6 feet away from residents (as much as is possible) until replacement staff arrive and they are able to leave the facility;
        3. Ensure they are wearing personal protective equipment;
        4. Immediately contact their supervisor and notify them that they must leave their shift due to COVID-19 symptoms.
      4. It is the responsibility of the supervisor to replace the symptomatic staff as soon as possible. Once the replacement team member arrives, the symptomatic staff must leave the facility immediately and remain away until testing confirms they do not have/no longer have COVID-19.
      5. It is the responsibility of the supervisor to quarantine the home and its residents and instruct team members to watch for symptoms among the residents.
        1. The home must remain under quarantine for a period of 14 days after the last symptoms were noted or all team members and residents have received negative COVID-19 test results.
      6. It is the responsibility of the supervisor to send additional team members into the home to implement sterilization of the facility.
    12. At a licensed residential or CLS site, if a resident expresses or displays symptoms of COVID-19 the lead team member on duty must:
      1. As much as is possible, quarantine the resident in a room away from all other residents and team members. In cases where the consumer cannot remain safe while quarantined alone in a separate room, one team member may have to remain in or near the quarantine room. In this situation, the team member must always wear personal protective equipment and maintain 6 feet distance from the symptomatic resident. Staff should only go nearer than 6 feet distance if the consumer needs assistance maintaining their health and/or safety;
      2. Contact the resident’s guardian (if applicable) to provide notification of the situation;
      3. Contact the resident’s primary care provider and follow their instructions. For medically fragile residents, it will be necessary to move the resident into a regional hub, hospital, or alternate care facility set up for evaluating and treating COVID-19.
        1.  If the resident has an advance directive, it is the responsibility of the Housing Monitor/designee to ensure that the resident’s advance directive accompanies the resident to the treating facility where they are admitted.
      4. If it is possible to leave the home of a CLS consumer without jeopardizing their health and safety, the team member should:
        1. Contact their supervisor and notify them that they are leaving the location because the consumer is displaying/expressing symptoms of COVID-19;
        2. Contact the consumer’s guardian or other natural support persons to assist in ensuring the consumer seeks medical advice.
      5. When a resident is confirmed to have COVID-19, it is the responsibility of the Housing Monitor to notify all team members associated with the care of that resident within 12 hours.
      6. If a resident of a licensed home or a CLS consumer chooses to move in with a person of natural support during the period of the pandemic, the consumer does not forfeit any right to return that would have been provided to them had they been hospitalized or placed on therapeutic leave.
        1. TLC will accept the return of the resident, provided the facility can meet the medical needs of the resident and there are no statutory grounds to refuse the return, as soon as capacity allows.
        2. TLC will require the resident have a negative COVID-19 test prior to re-entering the home.
  1. REMOTE SERVICE DELIVERY:
    1. Psychiatric, therapy, case management and supports coordination team members may continue to provide service delivery utilizing a broad range of remote communication options until (whichever comes first):
      1. 30 days after the end of Governor Whitmer’s emergency order; or, 
      2. The date payers determine to stop paying for services delivered using non-traditional, remote platforms.
    2. Psychiatric, therapy, case management and supports coordination team members are encouraged to plan for and implement migrating consumer contacts to company-approved, HIPAA compliant platforms at the earliest date possible based on:
      1. The consumer’s individual needs;
      2. The consumer’s access to technology and internet.
         
  2. TRAVEL: Team members may not travel in relation to their work functions for TLC until 30-days after the Governor’s “Stay Home, Stay Safe, Save Lives” executive order is lifted, except:
    1. To and from their worksite;
    2. In an emergency response to the health and safety of a TLC consumer (appropriate PPE must be worn);
    3. To provide essential needs for consumers at a CLS location (including food, medications, healthcare services).

Worksite Supervisor Schedule - Case Management

  MON TUES WED THURS FRI
8:00 AM Brittney Mackenzie Brittney Montrice Jessica
9:00 AM Brittney Mackenzie Brittney Montrice Jessica
10:00 AM Brittney Mackenzie Brittney Montrice Jessica
11:00 AM Brittney Mackenzie Brittney Montrice Jessica
12:00 PM Brittney Mackenzie Brittney Montrice Jessica
1:00 PM Brittney Mackenzie Brittney Montrice Jessica
2:00 PM Brittney Mackenzie Brittney Montrice Jessica
3:00 PM Brittney Mackenzie Brittney Montrice Jessica
4:00 PM Brittney Mackenzie Brittney Montrice Jessica
5:00 PM Brittney Mackenzie Brittney Montrice Jessica
6:00 PM Brittney Mackenzie Brittney Montrice Jessica

Worksite Supervisor Schedule - Therapy

  MON TUES WED THURS FRI
8:00 AM Rick Melissa Kim Kim Melissa
9:00 AM Rick Melissa Kim Kim Melissa
10:00 AM Rick Melissa Kim Kim Melissa
11:00 AM Rick Melissa Kim Kim Melissa
12:00 PM Rick Melissa Kim Kim Melissa
1:00 PM Rick Melissa Kim Kim Melissa
2:00 PM Rick Melissa Kim Kim Melissa
3:00 PM Rick Melissa Kim Kim Melissa
4:00 PM Rick Melissa Kim Kim Melissa
5:00 PM Rick Melissa Kim Kim Melissa
6:00 PM Rick Melissa Kim Kim Melissa

Worksite Supervisor Schedule - Med Clinic

  MON TUES WED THURS FRI
8:00 AM Brittney Mackenzie Brittney Montrice Jessica
9:00 AM Brittney Mackenzie Brittney Montrice Jessica
10:00 AM Rebecca Rebecca Rebecca Rebecca Rebecca
11:00 AM Rebecca Rebecca Rebecca Rebecca Rebecca
12:00 PM Rebecca Rebecca Rebecca Rebecca Rebecca
1:00 PM Rebecca Rebecca Rebecca Rebecca Rebecca
2:00 PM Rebecca Rebecca Rebecca Rebecca Rebecca
3:00 PM Rebecca Rebecca Rebecca Rebecca Rebecca
4:00 PM Rebecca Rebecca Rebecca Rebecca Rebecca
5:00 PM Rebecca Rebecca Rebecca Rebecca Rebecca
6:00 PM Rebecca Rebecca Rebecca Rebecca Rebecca